title: Comparison of dilatation & curettage and endometrial aspiration biopsy accuracy in patients treated with high-dose oral progestin plus levonorgestrel intrauterine system for early-stage endometrial cancer.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of dilatation & curettage (D&C) vs. endometrial aspiration biopsy in follow-up evaluation of patients treated with high-dose oral progestin plus levonorgestrel intrauterine system (LNG-IUS) for early-stage endometrial cancer (EC).
  
  
  METHODS
  A prospective observational study was conducted with 11 patients with FIGO grade 1 or 2, clinical stage IA endometrioid adenocarcinoma. Patients were aged up to 40 years wishing to preserve fertility treated with high-dose oral progestin plus LNG-IUS. Treatment response assessment was done at three month intervals. Endometrial tissues were obtained via endometrial aspiration biopsy with LNG-IUS in place and D&C after removal of LNG-IUS. We identified 28 cases; the histologic results were compared. Kappa statistics were used to assess the agreement of two methods.
  
  
  RESULTS
  Diagnostic concordance between examinations was assessed for 9 out of 28 cases examined (32.1%). These consisted of three cases with both examination results of normal, 3 cases with endometrioid adenocarcinoma, 1 case with complex endometrial hyperplasia, 2 cases with material insufficient for diagnosis. Endometrioid adenocarcinoma on D&C was diagnosed in 9 out of 28 cases, but from endometrial aspiration biopsy, only 3 of these 9 cases were diagnosed with endometrioid adenocarcinoma, giving the diagnostic concordance at 33% (kappa value=0.27). From endometrial aspiration biopsy, 17 out of 28 cases (60.7%) had material insufficiency for diagnosis.
  
  
  CONCLUSIONS
  In patients treated with high-dose oral progestin plus LNG-IUS for early-stage EC, endometrial aspiration biopsy with LNG-IUS in place may be not reliable as a follow-up evaluation method.
authors.affiliation: Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
authors.forename: Mi Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Seok Ju
authors.initials: SJ
authors.lastname: Seong
authors.forename: Taejong
authors.initials: T
authors.lastname: Song
authors.forename: Mi-La
authors.initials: ML
authors.lastname: Kim
authors.forename: Bo Sung
authors.initials: BS
authors.lastname: Yoon
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Jun
authors.forename: Gun Ho
authors.initials: GH
authors.lastname: Lee
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D044963:Biopsy, Fine-Needle; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D004717:Endometrium / Q000473:pathology*; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011372:Progestins / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D011372:Progestins; D016912:Levonorgestrel
keywords: Dilatation & curettage; Endometrial biopsy; Endometrial cancer; LNG-IUS; Progesterone